A Gardener’s War

Some guys love working in their yards, planting, digging, pruning – I confess, I’m not one of them. While I enjoy having a home surrounded by blooming plants, along with a hillside of fruit trees producing oranges, lemons, and in good years, nectarines, I contribute nothing to their maintenance and good health. Miki, on the other hand, is a true Taurus. She loves planting fresh flowers, working outside, and exercising her green thumb.

We are fortunate to have a pool in the yard, as well as a quiet spot on a hilltop at the end of a cul-de-sac, next to a city water reservoir surrounded by undeveloped land. This means a mini paradise for possums, raccoons, ground squirrels, moles, rabbits, and coyotes, along with an assortment of flying creatures from hummingbirds to hawks. They are given means, motive and opportunity. There is no way to truly control their activity, though this hasn’t kept Miki from trying. She has spent princely sums buying and planting flats of flowers, only to have them rapidly become rabbit or rodent food. While she has thrown in the towel in her attempts to grow tomatoes and grapes on the hillside, she remains undeterred in her war against the critters that routinely destroy her plants. (At $60 per salvaged tomato, along with the arrival of some truly ugly tomato worms, I was able to persuade her that it’s a lot more economic to get them at the Farmer’s Market or the store.)

While she grouses about the coyote coming around and leaving his poop around the pool deck for her to clean up, she at the same time is starting to appreciate the animal’s place in the food chain, keeping down the numbers of the destructive pests. Years ago, she declared open war on the moles and ground squirrels, who not only feast on her plants, but whose tunneling on the hillside makes it a major orthopedic risk for her to venture there. First, she read an article about keeping the offenders at bay using ultrasound devices buried in the dirt. She bought dozens of these (each requiring 4 D-cell batteries) only to find the tunnels adjacent to the devices, as the critters seemed to enjoy the massage of rubbing against the vibrating tubes.

She next resorted to hiring a pest service that would come twice a month to place poison pellets down the tunnels. While this method decreased the amount of infestation, it by no means eliminated it, especially as the neighbor on the other side of our fence provided safe haven to rodent refugees. Then, the man who provided the pest control service injured himself on a job, and went out of business. Surprisingly, it’s very difficult, at least in our area, to find someone who does this work with any degree of reliability.

As we are entering the third phase of what appears to be a remake of “Caddy Shack”, Miki has shifted strategy. One article she read proclaimed that coffee grounds or moth balls can help keep ground squirrels away. Do you have any idea of how much coffee grounds you need to cover a third of an acre of land? I do my part by drinking three cups every morning, but really! As for moth balls, not only are they expensive, but the smell would keep me away as well. So the latest plan is castor oil and liquid soap diluted with water, which can then be sprayed in the areas at risk. She just came home with a large stock of castor oil, no doubt making the lady at the checkout counter wondering about the state of  Miki’s bowels. I’ll keep you posted as the battle unfolds. In the meantime, Miki can continue to indulge her weed pulling OCD.

A Traditional Greeting of Hope in the Time of Pandemic

Welcome to another Monday’s Poem of the Week. Despite hope and best efforts, Covid-19 continues to impact our lives, with deaths in the USA alone now having reached the million mark.  For this reason, today’s verse is particularly appropriate. Be well, stay healthy.

A Traditional Greeting of Hope in the Time of Pandemic

My tribe is in Alaska, where winter temperatures

sometimes plummet to seventy degrees below zero.

In places, the sun does not rise for months at a time.

Surviving the long, dark winter was uncertain.

                                             Not all things made it.

Each spring, when we journeyed out into the sunlight

we smiled and greeted those we hadn’t seen in months.

               Dzidida’ we’d say. “So, you’re still alive.”

During the pandemic, I often thought of our greeting

when meeting someone I hadn’t seen in a long while.

• John E. Smelcer, PhD

Open Heart

As a student, seeing my first heart surgery was a profound experience. This Monday’s Poem of the Week does a remarkable job of capturing the mystery and the magic of this remarkable organ on which we all critically depend.

Open Heart

I didn’t know that the heart

twists

when it beats –

wrings itself, a

tight squeeze, then

bounces back to

continue –

exposed. I watch it dance,

naked to our eyes, like a

timid animal shying away, it is so much

smaller

than I expected, so much

more

than I thought it would be, my breath

catches

with the fluidity of the

cycle, my own heart

twists

beneath my sternum, reveling in the

rhythm, fiercely

alive.

• Zoe Onion

The More Loving One

Welcome to Monday’s Poem of the Week. I confess, I was never a huge Auden fan, but this poem speaks to the state of my mind today. See if it says anything to yours. Be well.

THE MORE LOVING ONE
by W.H. Auden

Looking up at the stars, I know quite well
That, for all they care, I can go to hell,
But on earth indifference is the least
We have to dread from man or beast.

How should we like it were stars to burn
With a passion for us we could not return?
If equal affection cannot be,
Let the more loving one be me.

Admirer as I think I am
Of stars that do not give a damn,
I cannot, now I see them, say
I missed one terribly all day.

Were all stars to disappear or die,
I should learn to look at an empty sky
And feel its total dark sublime,
Though this might take me a little time.

What We Carry

This Monday’s Poem of the Week was inspired by the the best seller about the Vietnam War of similar name. In any war, soldiers have to decide on what is most essential in carrying out their mission. Hope you enjoy today’s verse.

What We Carry

My first black bag too small

to hold my store of insecurities

I traded up to satchel size.

Mnemonics, formularies, vials

of scent to test that oft-ignored

first cranial nerve, reflex hammer,

tuning forks in several keys.

Eye charts, growth charts, BP

cuffs in several sizes, tape measure

cotton wisp, and a pin.

The medical equivalent

of a hardware store.

I carried it, a heavy comfort

all those years, then left it home.

Lighter now, silver haired, I enter rooms

alone save for a simple stethoscope

and a pair of ears.

• Edward M. McMahon Jr, MD

How Changes in Healthcare Will Affect You

There has been a tectonic change in the way medicine is being practiced in our country. It began in the early 1960’s, when the government and private insurance became the major payers for physician services, and accelerated in the early 1980’s as those same payers began to increasingly dictate the manner in which medicine should be practiced. Today, it has reached the stage that your doctor is more likely to be an employee of a large bureaucratic structure, be it an insurance company, a large hospital system, or in the case of the VA, the government. Contrary to popular opinion, the vast majority of health care dollars you spend do not end up in the pockets of those who provide your care. Rather, they fund the grand structures of both non-profit and for profit enterprises, whose course is being steered by executives whose monthly paychecks are anywhere from 10 to 100 times larger than those of the physicians they now control. Of note is the fact that these executives almost uniformly have never cared for a patient, or know much about medicine besides its business aspects. Despite a number of states still having laws on the books prohibiting the corporate practice of medicine, these laws have been either removed by the lobbying efforts of the American Hospital Association and the large insurance companies, or subverted to the point that they no longer matter.  Today, less than half of physicians are in any control of their practice, down from 95% just twenty years ago. And even the ones who are have to deal with a federally mandated morass of electronic health records (which do not communicate with one another), growing mountain of prior approvals, after the fact denial of payments, onerous regulations, and rising malpractice costs, forcing many to either retire or join the ranks of the employees.

Why should any of this matter to you, the patients? The answer is twofold. Most importantly, because it affects the kind of care you receive. When the bean counters decide that my productivity and their income will increase if they limit the time I have to interact with you to 5-10 minutes, my ability to decide and explain what is the best course of treatment for you problem becomes impaired. When your care gets shifted numerous times because of a change in the insurance plan you are offered, you no longer have a personal relationship or a level of trust you need to follow my recommendations. When the services I would provide to you are now being given by other “health care providers” who are not doctors, more subtle or unusual problems are more likely to be missed or ignored. And when you are unable to navigate the phone and bureaucratic triage system that has been erected to limit your access to my care, you suffer even more. Secondly, you should care because you are paying for all the layers of middlemen who are making an expensive system even more expensive.

Sadly, even those of us in the profession who know the intricacies of the system suffer similar problems when needing aid for ourselves and our families. Besides trying to support those who have provided good care to you in the past, and expressing your feelings to those officials in government who are driving many of the changes, there is little any of us can do. As the lobbying power of the hospitals and industry far outweigh those of doctors, the war no longer seems winnable. Perhaps the best we can hope for is that those of you who have children considering entering medicine as a profession do your best to instill in them the values that make them fight for the welfare of their patients over the dictates of the organization that will likely employ them. Otherwise, as one of my retiring associates recently told me, “we are never going to get the care we gave.”

Gerdy’s Tubercle

This Monday’s Poem of the Week is dedicated to all of you who experience periodic aches and pains as you move about, a process we associate with getting less young. Despite it all, we continue moving. After all, it’s more difficult to hit a moving target. 🙂

Gerdy’s Tubercle

part of the knee named after the French surgeon Pierre Nicolas Gerdy (1797-1856)

My acupuncturist encourages me to rub

the Chinese liniment on my Midwestern

ligament to heal the aching hill of my knee

and its valley of attachments.

Ingredients alchemized and prescribed

by a nameless master herbalist

hundreds of years ago, translate

simply to mean: Bone Water Fix.

I figure that the ointment, once used

to treat combat fractures of Asian soldiers,

will not discriminate against the hiking

pain I got going on here in Ohio.

My orthopedist, trained

in the eponymous naming of anatomical

landmarks, hesitates a bit before

shrugging: Sure, go ahead, use it

if you think it might work. He points

to the lateral condyle of the proximal

tibia where my iliotibial band and

anterior tibialis muscle inserts.

Rub it real good around your

Gerdy’s tubercle, he says, unpoetically.

We surgeons consider it to be

The Lighthouse to the Knee.

• Susan F. Glassmeyer

Dirge Without Music

It’s another Monday morning, so time for Monday’s Poem of the Week. It’s gray and overcast looking out at the mountains this morning. Over the weekend, we attended the funeral of yet another friend who served his patients and his country well, but has now moved on beyond our call and reach. The following classic is appropriate to how I, and many of you dealing with loss, feel.

DIRGE WITHOUT MUSIC
by Edna St. Vincent Millay

I am not resigned to the shutting away of loving hearts in the hard ground.
So it is, and so it will be, for so it has been, time out of mind:
Into the darkness they go, the wise and the lovely. Crowned
With lilies and with laurel they go; but I am not resigned.

Lovers and thinkers, into the earth with you.
Be one with the dull, the indiscriminate dust.
A fragment of what you felt, of what you knew,
A formula, a phrase remains, — but the best is lost.

The answers quick and keen, the honest look, the laughter, the love,—
They are gone. They are gone to feed the roses. Elegant and curled
Is the blossom. Fragrant is the blossom. I know. But I do not approve.
More precious was the light in your eyes than all the roses in the world.

Down, down, down into the darkness of the grave
Gently they go, the beautiful, the tender, the kind;
Quietly they go, the intelligent, the witty, the brave.
I know. But I do not approve. And I am not resigned.

When the Tanks Come Rolling In

For several weeks now, I have been unable to turn on the TV news. The images coming from Ukraine are too similar to almost suppressed but not forgotten memories from my childhood. I was well on the way to my tenth birthday when in October of 1956 the revolution ignited in Budapest. A group of university students were protesting for increased freedom at the radio station when they were machine gunned by the AVO, the Hungarian secret police. News of the massacre spread with incendiary speed throughout the city, and over a 100,000 people gathered in outrage in front of the Parliament building. The government panicked, calling out the army to back up the secret police, ordering them to fire on the crowd. Rather than killing their own people, the army joined them in fighting against the AVO forces, as well as those of the Russian army stationed within the country. For a brief time, fighting with only rifles against the superiorly equipped enemy, bolstered by Western promises of aid, the so called Freedom Fighters were able to push the occupying forces outside of the city. After three weeks of heavy street to street fighting, during which over 50,000 Hungarians lost their lives, Russian heavy armor backed by their air force brutally wiped out all resistance. The promised Western aid never came.

I was living in the center of the city, just off one of the main ring streets. I remember watching a Russian tank roll down our street, and when my horrified parents yanked me away from the window, hearing the eruption of the tanks cannon, followed by the crumbling of the walls of the building across the street where my friend lived. He survived. His parent’s did not. I remember kids not much older than me, covering their bodies with newspaper, pretending to be dead, than waiting for a tank to roll by so they could toss a Molotov cocktail underneath. I recall dodging between buildings during lulls in the firefights, trying to make our way to a bakery to find bread to eat. I remember stuffing my pockets with bullets of all calibers lying scattered around the pavement, and being able to see inside apartments with pianos and furniture teetering on the edge of floors as the building walls had been blown away, like scenes inside a grotesque doll house.

I spent years reliving those nightmare scenes until my new life and some later therapy helped to extinguish them. I never thought they would come back. Until now. Today, it’s the Ukrainians who are dying, waiting for the help they were promised. May God have mercy on us all.

How to Say Goodbye

Monday’s Poem of the Week addresses a theme that recently has been to familiar for many of us. I like it because it does so with elegance and hope. Wishing we all can do the same.

How to Say Goodbye

The gentleness seeps into corners.

You worry about leaving this world

unloved. As if once this happened,

all could stop. In the quiet these colors

appear soft. Caressed slowly by the

eyes, a fullness felt in every breath.

Silly things you never had time for

come out of the dark. And the moon,

unwavering in where it shines. Here

the words you’ll never say tumble out,

disappear underneath rain puddles. You

know where this fear comes from. There

is too much unknown. Yet, you still

find a place to call home. Following you,

the scene turns inward, to that silent

urge spending time tuning in minor key

with questions of careful tenderness. Which

is to say love, echoed on thin strings of brief

harmony. Even in this vast openness

there is intimacy. So much that

you believe you have arrived. That you

can let go. Watch the stars run their course.

And the waters their rhythm. as the wind

passes by the leaves briefly touch. You are

reminded of what could be. And what is.

• David Haosen Xiang